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A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation: Increased Estimated Spleen/Graft Volume Ratio

View Article: PubMed Central - PubMed

ABSTRACT

Background: In adult living donor liver transplantation (ALDLT), graft-to-recipient weight ratio of less than 0.8 is incomplete for predicting portal hypertension (>20 mm Hg) after reperfusion. We aimed to identify preoperative factors contributing to portal venous pressure (PVP) after reperfusion and to predict portal hypertension, focusing on spleen volume-to-graft volume ratio (SVGVR).

Methods: In 73 recipients with ALDLT between 2002 and 2013, first we analyzed survival according to PVP of 20 mm Hg as the threshold, evaluating the efficacy of splenectomy. Second, we evaluated various preoperative factors contributing to portal hypertension after reperfusion.

Results: All of the recipients with PVP greater than 20 mm Hg (n = 19) underwent PVP modulation by splenectomy, and their overall survival was favorable compared with 54 recipients who did not need splenectomy (PVP ≤ 20 mm Hg). Graft-to-recipient weight ratio had no correlation with PVP.

Results: Multivariate analysis revealed that estimated graft and spleen volume were significant factors contributing to PVP after reperfusion (P < 0.0001 and P < 0.0001, respectively). Furthermore, estimated SVGVR showed a significant negative correlation to PVP after reperfusion (R = 0.652), and the best cutoff value for portal hypertension was 0.95.

Conclusions: In ALDLT, preoperative assessment of SVGVR is a good predictor of portal hypertension after reperfusion can be used to indicate the need for splenectomy before reperfusion.

No MeSH data available.


Relationship between SVGVR and PVP after reperfusion according to MELD score. In high and low MELD, SVGVR showed a positive correlation with PVP (R = 0.581 and R = 0.692, respectively).
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Figure 7: Relationship between SVGVR and PVP after reperfusion according to MELD score. In high and low MELD, SVGVR showed a positive correlation with PVP (R = 0.581 and R = 0.692, respectively).

Mentions: As shown in Figure 7, in recipients with a high MELD scores of 15 or more (n = 23) as well as less than 15 (n = 32), there were significant correlations between SVGVR and PVP after reperfusion (R = 0.58 and R = 0.69, respectively). In addition, in the recipients with Child-Pugh B (n = 21) and Child-Pugh C (n = 26), there was a significant correlation between SVGVR and PVP after reperfusion (R = 0.76 and R = 0.51, respectively); however, in 8 recipients with Child-Pugh A, there was no significant correlation (R = 0.34). As shown in Figure 8, SVGVR had a significant correlation with PVP after reperfusion in left lobe grafts (n = 24, R = 0.573) as well as in right lobe grafts (n = 30, R = 0.735), respectively.


A Novel Predictor of Posttransplant Portal Hypertension in Adult-To-Adult Living Donor Liver Transplantation: Increased Estimated Spleen/Graft Volume Ratio
Relationship between SVGVR and PVP after reperfusion according to MELD score. In high and low MELD, SVGVR showed a positive correlation with PVP (R = 0.581 and R = 0.692, respectively).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120765&req=5

Figure 7: Relationship between SVGVR and PVP after reperfusion according to MELD score. In high and low MELD, SVGVR showed a positive correlation with PVP (R = 0.581 and R = 0.692, respectively).
Mentions: As shown in Figure 7, in recipients with a high MELD scores of 15 or more (n = 23) as well as less than 15 (n = 32), there were significant correlations between SVGVR and PVP after reperfusion (R = 0.58 and R = 0.69, respectively). In addition, in the recipients with Child-Pugh B (n = 21) and Child-Pugh C (n = 26), there was a significant correlation between SVGVR and PVP after reperfusion (R = 0.76 and R = 0.51, respectively); however, in 8 recipients with Child-Pugh A, there was no significant correlation (R = 0.34). As shown in Figure 8, SVGVR had a significant correlation with PVP after reperfusion in left lobe grafts (n = 24, R = 0.573) as well as in right lobe grafts (n = 30, R = 0.735), respectively.

View Article: PubMed Central - PubMed

ABSTRACT

Background: In adult living donor liver transplantation (ALDLT), graft-to-recipient weight ratio of less than 0.8 is incomplete for predicting portal hypertension (>20 mm Hg) after reperfusion. We aimed to identify preoperative factors contributing to portal venous pressure (PVP) after reperfusion and to predict portal hypertension, focusing on spleen volume-to-graft volume ratio (SVGVR).

Methods: In 73 recipients with ALDLT between 2002 and 2013, first we analyzed survival according to PVP of 20 mm Hg as the threshold, evaluating the efficacy of splenectomy. Second, we evaluated various preoperative factors contributing to portal hypertension after reperfusion.

Results: All of the recipients with PVP greater than 20 mm Hg (n = 19) underwent PVP modulation by splenectomy, and their overall survival was favorable compared with 54 recipients who did not need splenectomy (PVP ≤ 20 mm Hg). Graft-to-recipient weight ratio had no correlation with PVP.

Results: Multivariate analysis revealed that estimated graft and spleen volume were significant factors contributing to PVP after reperfusion (P < 0.0001 and P < 0.0001, respectively). Furthermore, estimated SVGVR showed a significant negative correlation to PVP after reperfusion (R = 0.652), and the best cutoff value for portal hypertension was 0.95.

Conclusions: In ALDLT, preoperative assessment of SVGVR is a good predictor of portal hypertension after reperfusion can be used to indicate the need for splenectomy before reperfusion.

No MeSH data available.